I was listening to the radio recently and the subject of nursing homes was being debated. The discussion centred on the "exorbitant" cost of nursing home care and one panellist proposed that if they reached the stage of needing care they would book themselves into a top-notch hotel, as it would be a cheaper alternative. I waited for the laughter, but no, this wasn't a joke.
I was amazed that on a serious radio programme, there was so little knowledge regarding the needs of those people who need nursing home care. I think it is unlikely that a "top-notch" hotel would include safe moving and handling, feeding, attending to personal hygiene needs (including laundry associated with continence problems) pressure relief and managing medication. I suppose that a visiting district nurse supplemented with additional paid carers could meet some of these needs, but this would not be cheap. By comparison, a good nursing home appears rather good value.
The panellists clearly had very little insight into the needs of those requiring 24-hour nursing care. Residents of nursing homes probably have the most complex nursing needs of any group of patients. The majority are elderly with multiple conditions associated with ageing of the human body. These problems, combined with the communication problems (and possibly mental health problems), all too common in advanced old age, present a huge clinical challenge.
Unfortunately, both the general public and the clinical professions show little enthusiasm for this challenge (unless the patient in question is a loved one). The majority of nurses would appear to view a job in a nursing home as a last resort and sometimes there appears to be an "us and them" relationship between community nurses working in or attached to GP practices and those working in nursing homes. The relatively low wages for nurses working in nursing homes simply reinforces the image of being the career choice of last resort.
If nursing homes are going to offer the standard of care that we wish our loved ones to receive, then we need to reach out and support our community colleagues working alongside us in the nursing homes. We need to find creative solutions to ensure that patients have access to the services and products they need but that wastage is avoided. For example, initiatives such as regular medicines reviews can help prevent inappropriate polypharmacy, which harms patients and wastes resources. Residents in nursing homes should have the same access to specialist clinical services, such as continence advice and specialist palliative care advice. We need to ensure that nursing homes are aware of these rights and know how to access such services.
The reality is that as people live longer but die more slowly, they are likely to require high-quality nursing care for the end stage of their lives. A local good quality nursing home that has developed close collaborative links with local GP and community services appears to offer remarkably good value compared to the nearest five-star hotel!
Your comments: (Terms and conditions apply)
"I am a newly-qualified nurse working in a nursing homem environment. I was forced into taking this career route due to the lack of employment opportunities in the mainstream NHS. I have had some positive and negative experiences working within this sector. Thankfully though we have a very supportive structure with the GPs surgeries and very strong links with the NHS due to it being a very large care home. I really agree with the nursing home residents being highly complex in their conditions. Diabetes management, hypertension, Parkinson’s, dementia, cerebral vascular accidents - these are just a few of the conditions us nursing home nurses face daily with just one resident. I personally feel nursing homes are given a bad press and the nurses are underestimated in their roles and seen as a lower level nurse. When really I personally have felt like I have learnt many new skills, which have been very beneficial to my personal development. I think more investment in training and links with the NHS should be made in the future" - Dawn Miles, Staff nurse, Manchester
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